Hand infections

Question 1

Which muscles put the fingers in the writing position?

Answer 1

LUMBRICALS

Question 2

What is the relevance of the pulp space?

Answer 2

• contains fat & is partitioned by septae
• terminal space is a closed compartment -> if pressure increases when there is an infection -> compression on terminal artery will lead to thrombosis resulting in osteomyelitis of terminal phalanx & gangrene

Question 3

What is the most dangerous zone in hand injuries?

Answer 3

Zone II (no man’s land)

Question 4

What are the precipitating causes of hand infections? What is the most common organism responsible?

Answer 4

• diabetes
• immunosuppression
• trauma
• HIV infection
• steroid therapy
• vascular diseases
• manual workers

STAPH AUREUS

Question 5

What are the local clinical features of hand infections?

Answer 5

• pain
• hotness & redness
• swelling: edema over dorsum (FROG HAND)
• loss of function
• tender palpable axillary lymph nodes

Question 6

Why should x-ray be done in case of hand infections?

Answer 6

to check for osteomyelitis

Question 7

What are the complications of hand infections?

Answer 7

• stiffness of digits & hand (ankylosis)
• deformity & disability
• local spread -> osteomyelitis, suppurative arthritis of joints
• distant spread -> bacteremia & septicemia
• gangrene & sloughing

Question 8

What treatment should be done for hand infections?

Answer 8

CONSERVATIVE

• hot fomentation
• antibiotic
• position of rest (glass holding position)
• position of function
• elevation of hand to reduce edema

INCISION & DRAINAGE
if there’s pus

Question 9

What is the most common hand infection & where does it occur?

Answer 9

ACUTE PARONYCHIA

• under eponychium due to minor injury to finger
• suppuration occurs very rapidly

Question 10

What are the clinical features of of acute paronychia?

Answer 10

• severe throbbing pain & tenderness

- visible pus under nail root (hang nail or floating nail)

Question 11

How should acute paronychia be treated?

Answer 11

OBLIQUE INCISION over eponychium to drain pus

if floating nail -> nail extraction

Question 12

What is the difference between acute & chronic paronychia?

Answer 12

ACUTE -> bacterial (staph a)

CHRONIC -> fungal

Question 13

What infection occurs beneath free edge of nail & pus comes to the surface?

Answer 13

SUBUNGUAL INFECTION

- in space between subungual epithelium & periosteum

Question 14

What are the features of a subungual infection & how should it be treated?

Answer 14

• excruciating tenderness with small visible pus under the tip of the nail
• V INCISION over the summit for drainage + antibiotics

Question 15

What is the terminal pulp space infection?

Answer 15

• 2nd most common
• in index & thumb
• due to minor finger prick
• could lead to osteomyelitis of terminal phalanx & gangrene (X-ray)

Question 16

how should terminal pulp space infection be treated?

Answer 16

OBLIQUE deep incision in terminal pulp

• treat osteomyelitis
• if there is gangrene in terminal phalanx -> amputate

Question 17

What is a characteristic sign of a web space infection?

Answer 17

V sign (separation of fingers)

Question 18

How should a web space infection be treated?

Answer 18

• horizontal incision on volar skin of the web & deepened to reach the space by dividing palmar fascia
• edges of the wound are cut to leave diamond shaped opening in the front
• counter-incision over dorsal web

Question 19

which hand infection will lead to a loss of concavity of the palm?

Answer 19

MID PALMAR SPACE INFECTION

Question 20

How should a mid palmar space infection be treated?

Answer 20

HORIZONTAL INCISION placed on volar aspect without crossing skin creases
- should be extended deep to palmar aponeurosis

Question 21

How is a thenar space infection treated?

Answer 21

OBLIQUE incision over medial aspect of thenar eminency

- stop 2cm distal to distal crease to avoid injury of motor branch of median nerve

Question 22

What are the types of acute suppurative tenosynovitis?

Answer 22

suppurative ulnar bursitis
suppurative radial bursitis
suppurative bursitis of middle 3 fingers

Question 23

What are the clinical features of acute suppurative tenosynovitis?

Answer 23

• symmetrical swelling of entire finger
• flexion of finger (hook sign)
• severe pain on extension

Question 24

What is Kanavel signs?

Answer 24

• swollen finger held in flexion

- exquisite pain on passive extension

Question 25

What is the treatment of acute suppurative tenosynovitis?

Answer 25

suppurative ULNAR bursitis -> radial aspect of hypothenar eminence
suppurative RADIAL bursitis -> ulnar aspect of thenar eminence
suppurative bursitis of MIDDLE 3 finger -> longitudinal or transverse incision (don’t cross skin crease)